Residential care

We will help you stay in your own home for as long as possible. However, if managing on your own or in the home of a relative becomes too difficult for you or your carer it may be necessary to consider moving into a care home.

Types of home

Some care homes, called private homes, are run as businesses. These homes normally set no restrictions on admission apart from a person’s suitability for care.

Other care homes are run by voluntary organisations, who might set conditions for accepting residents, for example people of a particular religion, or people who have served in the armed forces.

Residential care homes - These homes offer full board and personal care to those who need high levels of support with daily activities and occasional help at night.
Nursing homes - These homes are for those who need 24 hour care including the terminally ill. Nursing homes employ qualified nursing staff who are available day and night.
Dual registered homes – Some homes provide both residential and nursing care which means that residents who come to need nursing care in time may not have to move to another home.
Specialist homes - Some homes specialise in caring for people with dementia or functional mental illness, a disability, or those from a particular cultural, religious or professional background.

Registration

By law residential and nursing homes must be registered by the Commission for Social Care Inspection (CSCI). This independent public body regulates all care homes.

It must inspect all homes at least twice a year, and one of the visits must be unannounced, to ensure a high standard of care is being provided.

The findings of an inspection are detailed in a publicly available inspection report and it is written by a CSCI inspector, after their visit. It sets out what the service does well, or what it may need to improve on.

Inspection reports can be found on the CSCI website or by ringing the order line on 0870 240 7535.

Tel: 020 8420 0100 (local office)
Tel: 0845 015 0120 (general enquiries)
Fax: 020 8420 0119
Email: enquiries.harrow@csci.gsi.gov.uk
Website: www.csci.org.uk

Arranging your move to a care home

Making your own arrangements

If you are in a financial position to do so you can make your own arrangements to move into the home of your choice. CSCI or we, in the council, can give you information on homes in your preferred area.

If you later find that you can no longer afford the fees, the council will only assist you if you meet its eligibility criteria for support and the home where you are a resident is registered and prepared to enter into a contract with us, the council.

It is, therefore, advisable to request an assessment of your needs from us before you make a final decision about entering a home so that these issues can be discussed.

Making arrangements with council help

We will help you find the home best suited to your needs when you, your family or friends ask for assistance.

To offer you a real choice, we and the Primary Care Trust have contracts with a range of independent and voluntary sector homes including homes that meet both cultural or religious needs.

We can normally only directly help you make arrangements in the following circumstances:

your savings and capital assets are less than £21,000
you meet our eligibility criteria for support and your chosen home meets your assessed needs set out in your assessment
the home is registered, is prepared to accept you, and is prepared to enter into a contract with us to ensure a high standard of care
the cost of making arrangements for your chosen home is within the amount that we would usually expect to pay for accommodation for someone with your assessed needs.
there is a vacancy available for you in the home.

Your assessment

Whether you intend to make your own arrangements or hope that we will make arrangements for you, your needs will be assessed in exactly the same way.

The assessment will involve discussions with you, and with your permission, consultation with your family, friends, GP and other health service staff such as those who would be treating you if you were in hospital.

Your assessor will look with you to see what risks there are to you continuing to live independently, for example how safely and well you can manage daily activities like getting up and dressed.

You will be asked about your health, whether you remain involved with family and friends, and what support they can give you.

Your assessor will then be able to work out with you what you need and whether these needs meet our eligibility criteria for providing help.

Eligibility criteria

All assessments are carried out in accordance with nationally agreed eligibility criteria to ensure everyone is treated equally.

We will help if your assessment shows that you have a critical or substantial need for support.

Residential care would only be offered if you need a very high level of support with daily activities and possibly at night, and there are no carers available or your carers can no longer continue to help you.

Nursing care would only be offered if you need 24 hour care.

If a care home placement best meets your needs we will help with arrangements. This applies even when you have enough money to pay for your own care, if you cannot make the arrangements for yourself and you have no one else to do this for you.

Choosing a home

With the advice and information available from CSCI or us, you should be able to select a suitable home.

It is advised that you, or your family or friends, visit the home and you should ask to see the inspection visits reports.

If you require council funding for your placement but no suitable home can be found within our usual costs, then it will consider a home that costs more.

How is your choice affected by being in hospital

Following your admission to hospital, if you or the staff treating you feel that returning home or rehabilitative treatment would not be the best option, you will be offered an assessment of your need.

The social worker undertaking your assessment will help make arrangements if a care home placement best meets your needs.

If you can fund your own placement but feel you or your family need help in making the arrangements, the Placement Co-ordinator (an NHS employee) is available to help you.

Ward staff can arrange for you or your family to meet with the Placement Co-ordinator.

Your discharge to a care home

Once the acute phase (or rehabilitative phase where this is needed) of your illness/treatment is over, you must have arrangements in place for your discharge from hospital.

This is because a hospital ward is not the best place in which to regain your independence and there is also the possibility of catching an infection, which would slow your recovery.

It is also important that hospital beds (on both acute and rehabilitation wards) are available for other patients.

Temporary/transitional care

Sometimes it might be difficult for you to finalise your discharge plans because, for example, you have found a suitable home but it has no vacancy.

In these circumstances you will be assisted to move into a temporary setting until your preferred choice of home becomes available.

Choosing a more expensive home

Where you qualify for our help to pay your fees and the council can find you a suitable home within their usual costs you can only choose a more expensive home if:

someone else (for example a relative, friend or charitable organisation) agrees to pay a ‘top up’ - the difference between the actual fee for the placement and the amount the council would usually pay for similar suitable accommodation. The person who agrees to pay this difference is called a third party sponsor
very exceptionally, if you are being funded under property disregard or deferred payment schemes, you could pay the difference from your own funds.

Failure to keep up top up payments may result in you being asked to move to a suitable alternative home available at a cost the council would usually expect to pay.

However, if an assessment shows that your needs can only be met in your present home, you will be able to stay, with us, the council, meeting the difference in costs.

You and your family can discuss this with your social worker who can provide further information to you and your third party sponsor.

Reviewing your place in a care home

If we helped place you in a home, we will carry out a review of your situation after four weeks to check with you, your family and friends, and the home’s staff that the home is suitable for you.

If this is the case, your placement becomes permanent. We will then review your placement once a year unless you, your family or the home feel that your needs have changed. In this case an earlier review can be arranged.

Who pays for your care?

This will depend on many factors including the severity of your illness or disability and your financial situation. As a general guide, you could be:

fully funded – your fees would be met by the NHS or other Government sources, but in very limited circumstances
self funding – you have to pay your own costs
funded with council support – you will be funded in part by the council. You will be financially assessed to work out how much you can afford to pay towards the cost of your care.

Fully funded care

This is only available in very limited circumstances.

Continuing care - in some circumstances, where you are assessed as requiring a very high level of nursing care with constant supervision, the NHS will organise and pay for your continuing care in a hospital, a hospice or a nursing home.
Care for War Pensioners – available to those who qualify for help from the Veteran’s Agency with funding under the War Pensions Scheme.
Section 117 aftercare – available following a compulsory stay in a hospital for mental health treatment.

Who decides if you are self-funded or eligible for council support?

Following the assessment of your needs you will be advised about any likely charges. If it is possible that you would qualify for help with the charges you will be asked to complete a financial assessment form.

If you are unable to do this you family, carer or legal representative can help you. This form asks for details about your income, savings and other capital assets (e.g. any property you own).

From this form we work out whether you are entitled to financial assistance or whether you would have to pay for your own placement.

You should not try to dispose of any savings or capital assets you have (for example your home), in order to try and reduce your contribution to the cost.

If you do so, we will still include those savings and capital assets when your share of the charge is worked out.

Those who move to a nursing home are entitled to free nursing care. A nurse will assess your level of nursing needs and the home will be paid directly.

This ‘payment’ will have been taken into consideration by the nursing home when it sets its fees to you or to the council.

You pay

If you have savings and capital which amount to more than £21,000 you will have to pay your own costs. This is laid down by the Government [(National Assistance Assessment of Resources) Regulations 1992].

You might also have to pay if your income is high enough to meet the fees.

How Your Contribution Is Worked Out

Income

All your income including most of the pension and benefit you receive will be taken into account but you are entitled to retain a personal expenses allowance – a sum which the Government reviews each year.

If you have a pension or retirement annuity contract, even if your savings and capital are below the £21,000 level you will be expected to pay the care home fee from this income.

We will ignore up to half this pension or annuity if you are using it to support your wife, husband, and possibly, at their discretion, a partner.

Capital

Capital is any property, savings and investments, cash, premium bonds, stocks and shares that you have.

If you have joint savings or capital assets with your husband, wife, partner or another person, then a proportion will be taken into consideration.

Property, including your home, will be valued at its current market value less any outstanding mortgage. We will ignore the value of property if:

your husband, wife or partner is living there
another close relative lives there who is over 60, or has a disability, or is aged under 16 and is dependent on you.

The Government has ruled that the value of a person’s home will not be counted for the first 12 weeks following admission to a care home.

On this basis the council ignores the value of your home for 12 weeks from the time when your placement is made permanent when working out whether you qualify for support with funding. This scheme is called a property disregard.

In certain very limited circumstances the council can agree to defer part of the payment towards the cost of the placement. This is referred to as deferred payment.

The Government requires you to contribute a proportion of your savings between £12,500 and £21,000 towards the cost of your placement but savings below this are not taken into consideration.

Complaints

Once you have settled into your care home, if you have problems, it is best to talk with the staff concerned and try to get the problem sorted out straight away.

Each care home has a complaints procedure and if you are not satisfied following your initial discussions you should ask for that procedure to be followed and notify the local CSCI office of your concerns.

Where we are helping to pay the costs of the placement you should also contact Barnet Social Services Duty Team about the situation.

We and the CSCI will then investigate the matter, making sure that you are able to explain your concerns as part of that investigation.

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